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    • OAs can be divided into two groups

    2018-11-01

    OAs can be divided into two groups: mandibular advancement devices (MADs), which are attached to the teeth and move the mandible anteriorly, and tongue retaining devices, which use suction to position the tongue anteriorly inside a bulb [5]. MADs have higher success and compliance rates than tongue retaining devices [5] and have more scientific support for their use [6]. MADs are anchored to the teeth; therefore, their efficacy is directly related to the retention of the device to the dental arches [7]. Contraindications for treatment with these appliances include oral conditions with less than 10 teeth per arch [4], because this condition leads to lower retention and consequently failure of the treatment. Importantly, Brazil has a large number of lost teeth and edentulous people [8,9], and this ampar is contraindicated for MAD use due to total and/or partial tooth loss. This case report contains an alternative treatment using a MAD constructed on a complete upper and partial lower prosthesis in a patient with mild OSA.
    Case report The full night polysommnography was performed using a digital system (EMBLA (R) S7000, Embla System, Inc., Broomfield, CO., USA) and according to Academy American Manual (2007) [10]. The scoring of hypopnea events was made according to the alternative rules [10]. During a clinical examination, the patient showed a body mass index (BMI) of 29.8kg/m2 and neck circumference of 38cm. The oral examination showed complete upper denture, and a partial lower prosthesis constructed eight months before. The seven remaining teeth were a good periodontal condition and did not have caries. The alveolar ridge was good bone support and had a healthy aspect. The anchoring and stability of the prosthesis were evaluated and was satisfactory to do anchoring and stability of the MAD. The patient was informed that the treatment would be a therapeutic trial, and there was a possibility that the treatment would fail. As the amount of force that the device would apply to the prosthesis was unknown we did not have sure if the MAD would move these prothesis. Fig. 1 shows the oral condition of the patient with and without the prosthesis installed. Her prior dental history was requested, including photographs, panoramic x-rays, and lateral teleradiography. Next, molds were taken with the prosthesis in the mouth, and register the protrusion measured using a George Gauge. The maximum protrusion (from the maximum posterior contact to the maximum tolerable protrusion) was 7mm. The appliance was set to 50% when it was installed and advanced by 1mm per by week until the snoring complaint was over. The advanced was finish at 100% of maximum tolerable protrusion, at 7mm. She was submitted to a polysomnography after 5 months with a maximum tolerable protrusion position. Fig. 2 shows the patient with the MAD appliance installed. The treatment resulted in improvement on subjective sleepiness, ESS score was 4, on fatigue report and subjective and objective quality of sleep. On the polysomnogrpy parameters, the treatment decrease a sleep latency, REM latency, arousal index, AHI and increased of percentage of REM and N3 (Table 1).
    Discussion Treatment of edentulous patients with mild OSA is normally limited to CPAP or tongue retainers, which have low compliance [5,11]. The prevalence of OSA increases with age [2], and the prevalence of edentulous individuals is also high in the elderly population [8]. Using a MAD on a prosthesis is an alternative, as it is a low-cost treatment and does not require a power source [4]. Even though a tongue retainer ampar does not require dental support and is normally recommended for edentulous individuals, it has low compliance and produces several side effects, including irritation of the soft tissues and excess drooling [5]. In a randomized crossover study by Deane et al. [5], 91% of the patients preferred a MAD over a tongue retaining device and were more satisfied with MAD use. In this study, tongue retainer had a compliance rate of 27.3% for use more than six hours per night, while MAD showed a compliance rate of 81.8%, [5].